Gastroenterology Coding Alert

Question: The provider did an esophageal “motility study” to evaluate the function of muscles of the esophagus in a patient with severe acidity, who was not responding to medications. What are the coding options are possiblehere?

Maine Subscriber

Answer: ‘Esophageal manometry’ or the esophageal ‘motility study’ is a study to evaluate the function of muscles of the esophagus. In this test, the provider places a catheter with a sensor tip in the esophagus, to record pressure variations during swallowing and ingestion of food. Here are the three options based on the type of testing your provider performs.

Option 1: For the basic test you may report 91010 (Esophageal motility [manometric study of the esophagus and/or gastroesophageal junction] study with interpre­tation and report).

If your gastroenterologist practices in a hospital setting and does not own the equipment for the motility tests, you would bill the CPT^® 91010 with a modifier 26 (Professional component) assuming your physician performed the reading of the data from the catheter test. However, if your gastroenterologist owns the equipment, then you have to just stick to the appropriate test codes and bill globally without the use of any modifiers to include payment for both the professional and technical components.

Option 2: If the provider also orders acid perfusion (Bernstein) test studies along with manometry to confirm whether a symptom of chest pain has been really caused due to Gastroesophageal Reflux Disease (GERD), you will report the add-on code +91013 (...  with stimulation or perfusion…).

Option 3: It is generally not necessary to use an upper endoscope to place the motility catheter unless prior attempts to pass the catheter without the scope failed. If your provider had to resort to endoscopy to pass the catheter then you may report 43241 (Esophagogas­troduodenoscopy, flexible, transoral; with insertion of intraluminal tube or catheter).